DR. CORA LIM-MEDICAL INSIDER
Systemic Lupus Erythematosus
PART 9 (for March 24)
This is now Part 9 of our discussion of Systemic Lupus Erythematosus (SLE).
Comorbidities
Studies show that Coronary artery disease is more common in patients with SLE and aggressive management of conventional risk factors should be routine practice.
Hypertension, hyperlipidaemia and diabetes mellitus should all be treated aggressively. Modifiable risk factors, such as smoking, exercise and obesity, should also be addressed.
Patients with SLE often have low bone mineral density compared with age-matched healthy controls. Risk factors for osteoporosis should be assessed, including age, menopausal status, history of low trauma fracture, duration and current dose of corticosteroid treatment, family history, diet, smoking, alcohol, weight bearing exercise, malabsorption syndromes and lack of sun exposure.
Patients on prolonged courses of corticosteroids should have bone density measured using dual energy X-ray absorptiometry and vitamin D and calcium supplementation is often required.
Conclusions
Despite numerous failed studies of biologic agents over the past decade, several new therapies are being developed for use in SLE in large scale clinical trials around the world. However, despite recent advances in clinical treatment, SLE remains a huge challenge to clinicians across various disciplines.
Mortality in patients with SLE has improved dramatically over the last 50 years but patients still remain at significant risk of premature death due to atherosclerosis and infection. Earlier diagnosis and early aggressive treatment of disease, as well as comorbidities, will help to address this and improve outcomes.